Objective To study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.Methods Intestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. Results All operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leak age, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of follow up. Conclusion Compared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.

To better evaluate neuromuscular function of patients with stroke related motor dysfunction, we proposed an effective corticomuscular coherence analysis and coherent significant judgment method. Firstly, the related functional frequency bands in the electroencephalogram (EEG) were extracted via wavelet decomposition. Secondly, coherence were analysed between surface electromyography (sEMG) and sub-bands extracted from EEG. Further more, a coherent significant indicator was defined to quantitatively describe the similarity in certain frequency domain and phase lock activity between EEG and sEMG. Through the analysis of corticomuscular coherence during knee flexion-extension of stroke patients and healthy controls, we found that the stroke patients exhibited significantly lower gamma-band corticomuscular coherence in performing the task with their affected leg, and there was no statistically significant difference between their unaffected lag and the healthy controls, but with the rehabilitation training, the bilateral difference of corticomuscular coherence in patients decreased gradually.
Case-Control Studies ; Electroencephalography ; Electromyography ; Exercise Therapy ; Humans ; Knee ; physiology ; Muscle, Skeletal ; physiology ; Range of Motion, Articular ; Stroke Rehabilitation

Objective To explore the expression of antigen activated of macrophages ( MΦ) of bone marrow and its clinical significance in pancytopenia patients with positive bone marrow mononuclear cells (BMMNC)-Coombs test ( immunorelated pancytopenia, IRP) . Methods Sixty-one IRP patients, 10 severe aplastic anemia (SAA) patients and 13 healthy controls were enrolled in this study. The categories of auto-antibodies(IgG, IgM) on BMMNC(CD_(34)~+/CD_(15)~+/GlycoA~+ hematocytes), the quantity (CD_(68)~+/CD_(45)~+)% and expression of antigen activated ( CD_(69) ) of MΦ ( CD_(68)~+ CD_(69)~+/CD_(68)~+ ) % in bone marrow of all cases and controls were measured by fluorescence activated cell sorting( FACS). Results The quantity and expression ratio of activated antigen of bone marrow ( BM ) MΦ in IRP patients [ ( 0. 57 ± 0. 30 ) % and ( 40. 30 ± 18.49)%] were respectively significantly higher than those in SAA [ (0.46 ± 0. 08)% and ( 32. 44 ± 19.37)%] and healthy controls [ (0. 44 ± 0. 69)% and (29.71 ± 11. 67 )% ] ( both P < 0. 05 ). The quantity presented high-positive correlation with the expression ratio of activated antigen of BM MΦ ( r = 0.89, P<0. 01). Patients with IRP were classified into two subgroups according to the quantity of MΦ: Group A (MΦ≥0. 5% , 34 cases) and Group B ( MΦ <0. 5% , 27 cases). Thirty-two cases (94. 12%) were with auto antibody ( IgG) in Group A, while only 2 (7. 41% ) with auto antibody ( IgG) in Group B. There was significant difference in expression ratio of activated antigen of BM MΦ between Group A (49. 19 ± 16. 63) % and Group B (29. 11 ± 14. 30) % ( P < 0. 05 ) , but no difference was found between Group B and the control group (P >0. 05). Total curative rates at 3 and 6 month (47. 06% and 79. 41% ) of Group A were better than those of Group B (22.22% and 51.85%). Thirty-four IRP patients with autoantibody ( IgG) ( + ) were divided into two subgroups according to the quantity of MΦ: high level group ( >0. 75% , 9 cases) and low level group( <0. 75% , 25 cases) , 24 cases (96% ) in MΦ low level group were found auto-antibody (IgG) on one hemotopoietic cell lineage, 1 on two lineages, while 8 (88. 89% ) in MΦ high level group were detected auto-antibody (IgG) on two cell lineages, and 1 on three cell lineages. Expression ratio of activated antigen (56. 12 ± 15. 11) % was much higher in MΦ high level group than that in MΦ low level group (44. 58 ± 18. 16)% (P < 0. 05 ). The count of red blood cell concentration of hemoglobin and platelet in peripheral blood in MΦ high level group were respectively lower than those in MΦ low level group, while the percentage of Ret, the level of total bilirubin and indirect bilirubin, the ratio of erythroid of sternal bone marrow in MΦ high level group were higher than those in MΦ low level group. Conclusion The expression of activated antigen of BM MΦ was enhanced in IRP especially with autoantibody (IgG) , which might be involved in damage process of hemotopoietic cell.

OBJECTIVETo investigate the effects of angiotensin II (Ang II) antagonist telmisartan on retina vessel endothelial cell apoptosis and its impact on the ACE2-Ang-(1-7)-Mas axis in spontaneous hypertensive rats (SHR).

METHODSThirty-six SHR 16 week-old were randomly divided into 3 groups (n = 12 each): SHR, SHRT (telmisartan 10 mg · kg-1 · d-1 by gastric gavage) and SHRTA group (telmisartan 10 mg · kg-1 · d-1 by gastric gavage plus intravenous injection of A-779 0.5 mg · kg-1 · d-1), twelve WKY rats served as normotensive control group. Systolic blood pressure was measured at pre-treatment and 8 weeks later. After 8 weeks, rats were sacrificed, the expression of ACE2 and Mas in retina were analyzed by qRT-PCR, Western blot and Immunohistochemistry, the Ang-(1-7) concentration in serum was measured by ELISA. Specimens were obtained and stained by hematoxylin and eosin, and the morphology of retina vessel was observed. Apoptosis of vessel endothelial cells were determined by using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling method.

RESULTSThe systolic blood pressure of SHR, SHRT and SHRTA groups at baseline were significantly higher than age-matched WKY group (all P < 0.01). Eight weeks later, the systolic blood pressure group was significantly lower in SHRT group than in the SHR group (P < 0.01), this effect was partly reversed in SHRTA group. The retinal ACE2 mRNA and protein expression was significantly lower in SHR group than in WKY and SHRT groups (P < 0.01), which was similar between SHRT group and SHRTA group (P > 0.05). The retinal Mas mRNA and protein expression were significantly lower in SHR group compared to WKY and SHRT groups (all P < 0.01), which was significantly lower in SHRTA group than in the SHRT group (P < 0.05). ELISA results showed that serum Ang-(1-7) protein level was significantly lower in SHR group than in WKY group and SHRT group (both P < 0.05), which was lower in SHRTA group compared to SHRT group. Retinal vessel endothelial cell apoptosis was higher in SHR group than in WKY group, which could be reduced by cotreatment with telmisartan and this beneficial effect could be reversed by A-779.

CONCLUSIONTelmisartan can reduce retinal vessel endothelial cell apoptosis via upregulating the ACE2-Ang-(1-7)-Mas axis.

Angiotensin I ; metabolism ; Angiotensin II ; analogs & derivatives ; Angiotensin II Type 1 Receptor Blockers ; pharmacology ; Animals ; Apoptosis ; drug effects ; Benzimidazoles ; pharmacology ; Benzoates ; pharmacology ; Blood Pressure ; Endothelial Cells ; Peptide Fragments ; metabolism ; Peptidyl-Dipeptidase A ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Retina ; Systole ; Up-Regulation

Objective:To investigate the relationship between YES-related protein 1(YAP1)and prostate-specific antigen(PSA)in human castration-resistant prostate cancer(CRPC), and explore the regulation mechanism of YAP1 on PSA.Methods:The luciferase reporter gene was used to detect the activity change of the PSA gene promoter region after the over expression of YAP1 in LNCaP and C4-2 cells.The effect of over expression of YAP1 gene on PSA protein in different prostate cancer cell lines was detected by Western blot(WB)method, and the effect of YAP1 silencing on PSA protein in C4-2 cells was observed.The Q-PCR method was used to further verify the expression change of PSA mRNA affected by YAP1 gene over expressed in C4-2 cells.Meanwhile, WB was used to explore the effect of YAP1 on androgen receptor(AR)in C4-2 cells.Results:After over expression YAP1 in CRPC, the luciferase experiment showed that the average C4-2 cell ratio of experimental group to control group was 3.17815892(>2 times, P<0.001). After Q-PCR detection of all over-expressed YAP1 gene fragments, the measured PSA mRNA values in the experimental groups were 2.306667, 1.553333333, 2.613333333, and 2.673333333, respectively, which were higher than those in the control group(1 time, P<0.001), indicating that the PSA expression was significantly increased.WB analysis showed that after C4-2 cells over expressed YAP1, the AR band was significantly enhanced in the experimental group compared with the control group, suggesting that the AR protein expression in the nucleus was significantly increased in the YAP1 over expression group. Conclusions:YAP1 might positively regulate the PSA expression in CRPC and have an ability to promote AR translocation into the nucleus.

Objective:To introduce a method of combining autologous rib graft and a silicone plate as a composite graft for augmentation rhinoplasty.Methods:Twenty-two female patients were included in this series. Eleven cases had unsatisfactory nasal appearance Nine cases were admitted for postoperative graft warping, and refused to harvest a second costal cartilage, thirteen cases had limited amount of rib graft for harvest. When cartilage was insufficient for a full dorsal onlay graft, a L-shaped silicone nasal implant would be used and carved into a plate-like, so as to make into a composite graft with the cartilage on top of the silicone plate.Results:Up to 12-month follow-up was conducted, averaged 6.2 months. One case exhibited temporary ischemic signs at the incisions, resolved by compressive taping at day 5.For all other 21 cases aesthetic outcomes were satisfactory with no graft infection, extrusion or other complications. The dorsal only graft did not significantly transilluminate.Conclusions:Rib-silicone composite dorsal graft is an applicable and safe method in augmentation rhinoplasty surgeries, particularly when there is limited amount of cartilage available.

Objective:To explore the effect of pediatric critical illness score (PCIS), pediatric risk of mortality Ⅲ score (PRISM Ⅲ), pediatric logistic organ dysfunction 2 (PELOD-2), pediatric sequential organ failure assessment (p-SOFA) score and Glasglow coma scale (GCS) in the prognosis evaluation of septic-associated encephalopathy (SAE).Methods:The data of children with SAE admitted to the Pediatric Intensive Care Unit (PICU), Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences from January 2010 to December 2020 were retrospectively analyzed. They were divided into the survival and death groups according to the clinical outcome on the 28th day after admission. The efficiency of PCIS, PRISM Ⅲ, PELOD-2, p-SOFA and GCS scores for predicting death were evaluated by the area under the ROC curve (AUC). The Hosmer-Lemeshow goodness-of-fit test assessed the calibration of each scoring system.Results:Up to 28 d after admission, 72 of 82 children with SAE survived and 10 died, with a mortality rate of 12.20%. Compared with the survival group, the death group had significantly lower GCS [7 (3, 12) vs. 12 (8, 14)] and PCIS scores [76 (64, 82) vs. 82 (78, 88)], and significantly higher PRISM Ⅲ [14 (12, 17) vs. 7 (3, 12)], PELOD-2 [8 (5, 13) vs. 4 (2, 7)] and p-SOFA scores [11 (5, 12) vs. 6 (3, 9)] ( P<0.05). The AUCs of PCIS, PRISM Ⅲ, PELOD-2, p-SOFA and GCS scores for predicting SAE prognosis were 0.773 ( P=0.012, AUC>0.7), 0.832 ( P=0.02, AUC>0.7), 0.767 ( P=0.014, AUC>0.7), 0.688 ( P=0.084, AUC<0.7), and 0.692 ( P=0.077,AUC<0.7), respectively. Hosmer-Lemeshow goodness-of-fit test showed that PCIS ( χ2=5.329, P=0.722) predicted the mortality and the actual mortality in the best fitting effect, while PRISM Ⅲ ( χ2=12.877, P=0.177), PELOD-2 ( χ2=8.487, P=0.205), p-SOFA ( χ2=9.048, P=0.338) and GCS ( χ2=3.780, P=0.848) had poor fitting effect. Conclusions:The PCIS, PRISM Ⅲ and PELOD-2 scores have good predictive ability assessing the prognosis of children with SAE, while the PCIS score can more accurately evaluate the fitting effect of SAE prognosis prediction.

Objective: To investigate the change of autophagy level of bone marrow nucleated red blood cell (RBC) in patients with myelodysplastic syndromes (MDS) . Methods: Fifty-four MDS patients and thirty-three controls were enrolled in this study. The mitophagy were observed by transmission electron microscopy (TEM) . The level of autophagy-associated protein LC3B in GlycoA⁺ nucleated RBC was measured by flow cytometry. The expressions of ULK1 and mTOR mRNA in GlycoA⁺ nucleated RBC were measured by real-time PCR. The expression of the mitochondrial outer membrane protein TOM20 in GlycoA⁺ nucleated RBC was detected by Western blot. Results: Autophagosomes or autolysosomes were scarcely observed by TEM in MDS patients. The expression of LC3B in GlycoA⁺ nucleated RBC in high-risk MDS patients (0.22±0.12) was significantly lower than that in normal controls (0.43±0.22, P<0.001) , and lower than that in low-risk MDS patients (0.40±0.16, P=0.001) . The expression of AMPK [0.26 (0.60) ] in GlycoA⁺ nucleated RBC in high-risk MDS patients was significantly lower than that in controls [1.00 (2.07) , P<0.017) . The expression of ULK1 mRNA in GlycoA⁺ nucleated RBC in high-risk MDS patients [0.27 (3.31) ] was significantly lower than that in controls [1.07 (4.41) , P<0.017]. The level of mTOR mRNA in GlycoA⁺ nucleated RBC in high-risk MDS patients [1.82 (3.74) ] was significantly higher than that in controls [1.26 (1.38) , P<0.017]. The level of LC3B in GlycoA⁺ nucleated RBC was negatively correlated with the HGB (r=0.529, P=0.009) in high-risk MDS patients. The expression of mitochondrial outer membrane protein TOM20 in high-risk MDS patients was 9.42±4.42. Conclusion Autophagy is impaired in nucleated RBC of MDS patients.

Objective: To explore characteristic and function of peripheral blood mononuclear cells (PBMNC) -induced macrophages in patients with myelodysplastic syndrome (MDS) to couple with its progression. Methods: A total of 24 MDS patients (11 low-risk patients and 13 high-risk group patients) referred to Department of Hematology of Tianjin Medical University General Hospital and normal controls were enrolled from September 2014 to December 2015. PBMNC was stimulated with GM-CSF to transform to macrophages. The morphology of macrophages was observed by microscope. The quantity of macrophages, CD206 and SIRPα on surface of macrophages were detected by flow cytometry. The phagocytic function of macrophages was analyzed by fluorescence microscopy and flow cytometry. Results: The morphology of macrophages from MDS patients was abnormal. The percentage of transformed macrophages was (5.17±3.47) % in patients with MDS, which was lower than that in controls significantly[ (66.18±13.43) %, t=3.529, P=0.001]. The expression of CD206 on macrophages from MDS patients was significantly lower than that of controls[ (9.73±2.59) % vs (51.15±10.82) %, t=4.551, P<0.001]. The SIRPα level of macrophages from MDS patients was significantly lower than that of controls [ (0.51±0.09) % vs (0.77±0.06) %, t=2.102, P=0.043]. The phagocytic index and the percentage of phagocytic of macrophages from MDS patients were significantly lower than those of macrophages from normal controls[0.45±0.08 vs 0.92±0.07, t=-6.253, P=0.008; (23.69±3.22) % vs (42.75±2.13) %, t=-6.982, P=0.006 respectively]by flow cytometry. The phagocytic index of MDS patients was significantly lower than that of controls (0.24±0.04 vs 0.48±0.96, t=3.464, P=0.001) by fluorescence microscopy. Conclusion The quantity, recognization receptors and phagocytosis of PBMNC-induced macrophages decreased in MDS patients.

Objective:To explore the risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (upper tract urothelial carcinoma, UTUC).Methods:We retrospectively analyzed the data of 815 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between June 2009 to June 2019.There were 519 males and 340 females, aged from 26-93 years old(average 66.5±9.6 years old). 396 patients were renal pelvic caicinoma.463 patients were ureteral caicinoma.675 patients were accompanied with hydronephrosis.664 patients were accompanied with preoperative gross hematuria. Preoperative diagnostic ureteroscopy was performed in 323 cases.283 patients had the history of smoking.48 patients were con-comitant with bladder carcinoma at the first diagnosis. Univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for bladder recurrence after UTUC radical surgery.Results:Among the 859 patients, 407 (47.4%) had low-stage tumor (T is/T a/T 1), 452 (52.6%) had high-stage tumor (T 2-T 4), 110 (12.8%) had low-stage tumor (G 1/G 2), and 749 (87.2%) had high-stage tumor (G 3). 126 (17.2%) of 859 patients had relapse during the follow-up period, the average follow-up time was 17 months, the median recurrence time was 12 months, 101(80.1%) of the relapse occurred within 2 years after operation. In univariate analysis, lower tumor stage ( P=0.047), higher tumor grade ( P=0.043), preoperative hematuria symptom ( P=0.023) and preoperative diagnostic ureteroscopy ( P=0.002) were closely related to bladder recurrence. Taking the above factors into the logistic multivariate regression analysis showed that tumor staging T is/T s/T 1 ( B=0.476, P=0.019), tumor grade G 3( B=0.848, P=0.024), preoperative hematuria symptom ( B=0.521, P=0.048), preoperative diagnostic ureteroscopy( B=0.521, P=0.002) were independent risk factors of postoperative recurrence of bladder. Conclusion:lower tumor stage, higher tumor grade, preoperative hematuria symptom and preoperative diagnostic ureteroscopy are the independent risk factors of postoperative bladder recurrence in patients with UTUC. Routine intravesical chemotherapy should be performed in patients with UTUC with the above risk factors, and routine diagnostic ureteroscopy is not recommended.